Pull-out strength evaluation of cement augmented iliac screws in osteoporotic spino-pelvic fixation

Oberkircher, Ludwig; Masaeli, Adrian; Hack, Juliana; Figiel, Jens; Bliemel, Christopher; Ruchholtz, Steffen; Krüger, Antonio

doi:10.1016/j.otsr.2021.102945

Cited by 7 publications

(4 citation statements)

References 36 publications

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“…Additionally, a misplaced screw is reported as one of the main reasons for the screw loosening in patients with ASD after spinopelvic fixation [ 10 ]. Other surgical strategies were also attempted to prevent screws from loosening after long construct fusion such as cement-augmented IS [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of the Caudal Screw Loosening after Pelvic Fixation for Adult Spinal Deformity: A Systematic Review and Meta-analysis

Zhao,

Nie,

Zhou

et al. 2024

Asian Spine J

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The purpose of this study was to assess the factors affecting caudal screw loosening after spinopelvic fixation for adult patients with spinal deformity. This meta-analysis calculated the weighted mean difference (WMD) and odds ratio (OR) using Review Manager ver. 5.3 (RevMan; Cochrane, London, UK). The loosening group was older than the control group (WMD, 2.17; 95% confidence interval [CI], 0.48–3.87; p=0.01). The S2 alar-iliac (S2AI) could prevent the caudal screw from loosening (OR, 0.43; 95% CI, 0.20–0.94; p=0.03). However, gender distribution (p=0.36), the number of fusion segments (p=0.24), rod breakage (p=0.97), T-score (p=0.10), and proximal junctional kyphosis (p=0.75) demonstrated no difference. Preoperatively, only pelvic incidence (PI) in the loosening group was higher (WMD, 5.08; 95% CI, 2.71–7.45; p<0.01), while thoracic kyphosis (p=0.09), lumbar lordosis (LL) (p=0.69), pelvic tilt (PT) (p=0.31), pelvic incidence minus lumbar lordosis (PI–LL) (p=0.35), sagittal vertical axis (SVA) (p=0.27), and T1 pelvic angle (TPA) demonstrated no difference (p=0.10). PI–LL (WMD, 6.05; 95% CI, 0.96–11.14; p=0.02), PT (WMD, 4.12; 95% CI, 0.99–7.26; p=0.01), TPA (WMD, 4.72; 95% CI, 2.35–7.09; p<0.01), and SVA (WMD, 13.35; 95% CI, 2.83–3.87; p=0.001) were higher in the screw loosening group immediately postoperatively. However, TK (p=0.24) and LL (p=0.44) demonstrated no difference. TPA (WMD, 8.38; 95% CI, 3.30–13.47; p<0.01), PT (WMD, 6.01; 95% CI, 1.47–10.55; p=0.01), and SVA (WMD, 23.13; 95% CI, 12.06–34.21; p<0.01) were higher in the screw loosening group at the final follow-up. However, PI–LL (p=0.17) demonstrated no significant difference. Elderly individuals were more susceptible to the caudal screw loosening, and the S2AI screw might better reduce the caudal screw loosening rate than the iliac screws. The lumbar lordosis and sagittal alignment should be reconstructed properly to prevent the caudal screw from loosening. Measures to block sagittal alignment deterioration could also prevent the caudal screw from loosening.

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Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of the Caudal Screw Loosening after Pelvic Fixation for Adult Spinal Deformity: A Systematic Review and Meta-analysis

Zhao,

Nie,

Zhou

et al. 2024

Asian Spine J

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“…For example, Ebata et al [34] found that bilateral dual iliac screws could markedly reduce the loosening rate than the common bilateral single iliac screw (9% versus 61%, p<0.001). For osteoporosis patients, cement-augmented iliac screws could be an optimal method to reduce the loosening rate [35]. Furthermore, effective anti-osteoporotic therapy could also decrease the aforementioned internal fixation-related complications [36].…”

Section: Discussionmentioning

confidence: 99%

Multiple-Rod Constructs in Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

Zhao,

Nie,

Zhang

et al. 2023

Asian Spine J

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The purpose of this research was to compare the therapeutic efficacy of multiple-rod constructs vis-a-vis 2-rod constructs in the treatment of adult spinal deformity. A systematic review and meta-analysis were performed to determine whether the multiple-rod construct outperformed the 2-rod construct. We initially retrieved 357 papers, but only 12 were chosen for further meta-analysis. The rod breakage rates in the multiple-rod and the 2-rod groups were 10.66% and 29.87%, respectively. The multiple-rod construct inhibited rod breakage (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.19–0.41; p<0.001), pseudarthrosis (OR, 0.30; 95% CI, 0.18–0.50; p<0.001) and rod fracture at the osteotomy site (OR, 0.34; 95% CI, 0.13–0.89; p=0.03). Furthermore, the multiple-rod construct reduces the risk of revision surgery (OR, 0.38; 95% CI, 0.20–0.73; p=0.04) as well as the revision risk of pseudarthrosis/rod fracture in the multiple- rod group (OR, 0.31; 95% CI, 0.18–0.52; p<0.001), but increases the risk of caudal screw loosening (OR, 4.99; 95% CI, 1.87–13.30; p=0.001). There was no statistically significant difference in proximal junctional kyphosis (PJK) parameters (p=0.85), cerebrospinal fluid leakage (p=0.09), wound infection (p =0.71), age at surgery (p=0.62), gender distribution (p=0.93), body mass index (p =0.86), smoking status (p=0.05), hospital stay (p=0.09), osteoporosis (p=0.95), CoCr rod material (p=0.15), bone morphogenetic protein-2 (p=0.58), L5/S1 interbody fusion (p=0.07), high-grade osteotomies (p=0.07), the number of fusion levels (p=0.11), operation time (p=0.30), and blood loss volume (p=0.34). Regarding radiographic parameters, only preoperative sagittal vertical axis was found to be higher (weight means difference [WMD], 25.60; 95% CI, 15.43–35.77; p<0.001) in the multiple-rod group. There was no difference in preoperative Oswestry Disability Index (ODI) (WMD, −3.32; 95% CI, −7.38 to 0.73; p=0.11), but the multiple-rod group had a lower ODI at follow-up (WMD, −7.71; 95% CI, −11.62 to −3.86; p<0.001). Multiple-rod constructs could prevent rod breakage and pseudarthrosis while also lowering the revision rate, resulting in a better clinical outcome than the 2-rod construct. Nonetheless, due consideration should be given to PJK and screw loosening in multiple-rod constructs, possibly due to the increased stiffness caused by the multiple-rod structure.

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“…Bei der erst genannten Methode empfiehlt sich die Verwendung von kanülierten, bei der zweiten Methode die Verwendung von fenestrierten Schrauben. Oberkircher et al [13] konnten im Rahmen einer biomechanischen Kadaverstudie an 30 weiblichen, osteoporotischen Ileumknochen zeigen, dass sich zwischen beiden Techniken kein signifikanter Unterschied der Ausreißstabilität zeigte, jedoch beide Verfahren signifikant stabiler als die ledige Schraube ohne Zement waren.…”

Section: Literaturunclassified

Zement am Becken: Wohl oder Wehe?

Palm,

Groh,

Perl

2023

Die Wirbelsäule

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Zusammenfassung Einleitung Pathologische Knochenmorphologie und Frakturen, sei es durch osteoporotische Veränderungen oder bösartige Prozesse, erfordern besonders stabile, im Idealfall auch minimalinvasive Osteosyntheseverfahren. Die additive Nutzung von Knochenzement hat hier Vor- aber auch Nachteile. Ziel dieses Literaturreviews ist es daher, die führenden Indikationen sowie Vor- und Nachteile für die Zementapplikation am Becken näher zu beleuchten. Material und Methoden Es wurde eine PubMed-Recherche mit Fokus auf die Suchbegriffe „cement, pelvic“ durchgeführt (648 Einträge) und die für die vorliegende Fragestellung besonders relevanten Artikel wurden ausgewertet. Ergebnisse und Diskussion Die aktuelle Literatur setzt sich im Wesentlichen mit folgenden 4 Themenfeldern auseinander: Zementoplastie, Zementaugmentation sakroiliakaler Schrauben bzw. iliakaler Schrauben und perkutane Fixierung durch interne zementierte Schraube. Es zeigt sich – bei strenger Indikationsstellung – eine weitgehend zuverlässige, sichere und zumeist minimalinvasive Anwendbarkeit von Zement bei o. g. Techniken, die eine niedrige Komplikationsrate aufweisen.

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Pull-out strength evaluation of cement augmented iliac screws in osteoporotic spino-pelvic fixation

Cited by 7 publications

References 36 publications

Incidence and Risk Factors of the Caudal Screw Loosening after Pelvic Fixation for Adult Spinal Deformity: A Systematic Review and Meta-analysis

Incidence and Risk Factors of the Caudal Screw Loosening after Pelvic Fixation for Adult Spinal Deformity: A Systematic Review and Meta-analysis

Multiple-Rod Constructs in Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

Zement am Becken: Wohl oder Wehe?

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